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One of the most horrifying powers available to Cainites. Vicissitude is the signature power of the Tzimisce and is almost unknown outside of the clan. With it an experienced crafter can sculpt the flesh and bone of a subject, making them a creature of alien beauty or gnarling them into a deformed monstrosity. Tzimisce use Vicissitude on themselves extensively, altering their appearances with their mood or changing their bodies to be as vile as their souls.

Vicissitude is similar in some respects to Protean, but springs from a much darker source. Whereas Protean merely enables a Cainite to emulate God's creatures, this twisted power allows a Tzimisce to defile and deform those creatures or him/herself for all manner of perverse ends. The most beautiful maiden or noble stallion can, with but a knead of the fingers or a flick of the wrist, be reduced to a hideous freak or a blob of deliquescent pus. The Fiends have certainly used Vicissitude's more grotesque side effects to cement their infamous reputation.

Note that while this Discipline permits powerful and horrific effects, the wielder must obtain skin-to-skin contact and must often physically sculpt the desired result. This even applies to the use of the power on oneself. Tzimisce skilled in Vicissitude are often inhumanely beautiful; those less skilled are simply inhuman.

Outside of Thaumaturgy, Vicissitude is the most versatile of the Disciplines, and is often used in tandem with extensive ghouling. Tzimisce tend to deform their servants into war-forms szlachta, which are optimized for combat through extensive bone plating, spiked forearms and other modifications. True masters of fleshcrafting are capable of fusing multiple victims together into mammoth killing machines known as vozhd, but such creations are incredibly rare. Vicissitude was also used to create the Blood Brothersbloodline, and their Discipline Sanguinus is a derivation of the Tzimisce art. While its effects are normally permanent, vampires of lower generation can heal fleshcrafting transformations over time. Likewise, the Clan Curse of the Nosferatu cannot be removed through use of Vicissitude.

The nature of Vicissitude is shrouded in mystery, with even the most elder Fiends only speculating as to its origins and true potential. More than just a Discipline, it seems to act as a virus that "infects" others through transmission of blood. It is assumed to be invented by the Tzimisce Antediluvian, with some speculating that Vicissitude itself is an extension of the Elder Tzimisce and that it continues to learn and experiment through those that fleshcraft. The Tzimisce themselves view the control over physical forms granted by the Discipline as proof of their superiority over mortals who are slaves to their bodies. Practitioners of the Path of Metamorphosis go a step further and consider Vicissitude the path to achieve individual evolution and transcendence through a somewhat scientific approach of research and experimentation. Voices in the Shadow Crusade believe that Vicissitude is instead connected to the Iryi Aretstikapha, who dwells in the qlippothic shells of anti-being and who reaches into the material world through the use of the discipline.

God's curse is reflected in Vicissitude in that it replaces the ability to nurture and care with the ability to rend and corrupt. Advanced users find that the discipline develops a certain degree of independent existence: Spontaneous flesh- and bone-crafting effects manifest from time to time, usually as a response to outside stimuli. A threatened Tzimisce might find herself growing claws, while one caressing a favored servant might find herself altering said servant to be more beautiful.

Malleable Visage: A vampire with this power may alter his or her bodily parameters: height, build, voice, facial features, and skin tone, among other things. Such changes are cosmetic and minor in scope. He or she might, for example, resume his or her mortal coloration; make him/herself resemble a Moor, Viking, or Saracen, or even copy the form of a web-fingered naiad or faerie noble.

In Dirty Secrets of the Black Hand, Vicissitude was said to be a parasite that originated in the Deep Umbra and was brought back by a Tzimisce named Andeleon. As a disease, it eats away at the body, mind, and soul of an infected individual until they are consumed and taken over by it, becoming a Souleater. Supposedly the Old Clan Tzimisce were the few Fiends able to isolate themselves and avoid becoming infected. The True Black Hand was devoted to wiping out the alien invasion, while at the same time keeping it a secret from the world.[1]

The idea of Souleaters and Vicissitude as an alien plague received a great deal of criticism and was a divisive element of canon. The Vampire Storytellers Handbook Revised stated the idea was merely the result of a "lunatic fringe" within the Old Clan Tzimisce,[2] and to be disregarded. However, the Guide to the Sabbat reintroduced an optional rule with Vicissitude as a disease that can infect anyone that comes into contact with tainted blood. Infection is necessary for learning Vicissitude, and the degree to which one is afflicted influences the difficulty of learning levels of the Discipline. Instead of taking over a practitioner's mind, however, the disease makes it more likely those infected gain derangements.